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I talk a lot about the problems with standard speakerphone medical alerts. So what’s the problem, really?

The companies will tell you that even though you can’t have a conversation through the speakerphone, they’ll still send help.

Sure. But let’s look at two possible ways that could happen.

1. I’m outside.

Let’s say I’m outside in the garden and I fall. I’m on the far side of my raspberry patch, out of direct site from the house.

I press my button. The light on the button goes on, showing that I’ve pressed it. But there’s no actual confirmation that they signal was received. I’m outside, so I can’t hear the machine dialing, and I can’t hear the automated voice prompts saying that it’s dialing for help. So I really don’t know if it’s even working.

After 45 seconds or so, the monitoring center picks up and asks me if everything is okay. I can’t hear them. They don’t hear me. They ask a few times if I’m okay. I still don’t answer, because I still can’t hear them.

Now they disconnect the call and try to call me on the phone. The phone in the house rings. If I can hear it, I now know that probably they got my call. But maybe I can’t hear it, so maybe I still don’t know if my call for help got answered.

In any case, I don’t answer the phone. The monitoring center then follows their standard protocol. They dial up my local EMS and let them know that they’ve received a medical alarm activation from my address but I can’t be reached.

Now it’s up to the local emergency services to respond as they see fit.

On a good day, that means an ambulance is on its way. On a bad day, the dispatchers are trying to coordinate the response to several different emergencies and my “unknown” emergency may not get as high a priority as a clear-cut report of a life-threatening event.

Either way, they don’t know where I am. So when they arrive at my house and I don’t answer the door, they break it down and search the house for me. I’m not there, so they come looking in the back garden, where they finally find me lying by the raspberries.

If the reason for my fall was a heart attack, things aren’t looking good. I’m better off than if I didn’t have a medical alarm at all, but nowhere near as good as if I’d been able to communicate through the pendant. Time has been lost, your door is broken down, and the medical alert monitoring center is no longer on the phone.

If the fall wasn’t life-threatening (let’s say I just fell and couldn’t get up), I’ve just gotten an emergency response to something that didn’t need it. If I’d had a two-way system, I could have just let the responders know I needed your neighbor to come by and help me back to your feet.

2. There’s a fire.

In this scenario, I wake up in the night and realize the house is on fire. I’m trapped in my bedroom, where I don’t have a phone.

(I’ve seen this scenario in newspaper accounts of people who died after activating their medical alarms.)

I press my medical alert button, but the speakerphone is far enough away, and through a door, that they responder can’t hear me. They go through the same protocol as before, calling the house and then notifying the local emergency services. Because they don’t know what’s happening (perhaps my fire alarms were disconnected, so they didn’t hear the alarms going off over the speakerphone), they don’t know to send the fire department. Instead an ambulance arrives, then they have to call the fire department, and by the time help arrives it might easily be too late.

By contrast, if I’d had a 2-way system, I could have let the operator know right away that the house was on fire. They could have called the fire department without any delays, and they would know exactly where in the house I was and how to get to me.